Basic Information
| Provider Information | |||||||||
| NPI: | 1073660775 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | UJUETA | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | MARIA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7200 NW 19TH ST | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331261200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055002009 | ||||||||
| FaxNumber: | 3055002145 | ||||||||
| Practice Location | |||||||||
| Address1: | 5201 HOLLYWOOD BLVD | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330216422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549815200 | ||||||||
| FaxNumber: | 9549811614 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA9102547 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | PA9102547 | 01 | FL | PHYSICIAN ASSISTANT LICEN | OTHER |